What has happened to the “Doctors to the Barrios” (DTTB) programme? Not
much has been heard of the government project that then Philippines' Health
Secretary Juan Flavier pioneered in 1993, which encouraged medical graduates to
consider spending a couple of years or so of their professional practice in
some of the country’s poorest and most remote barrios (villages), where
healthcare needs are at their direst.
Flavier launched the DTTB after
the Department of Health discovered that some 271 towns in the country had had
no municipal physician for 10 years or more. The programme, according to
current Health Secretary Enrique Ona, aimed to address this gap by providing
“equitable healthcare services to all areas of the country by deploying
competent, committed, community-oriented and dedicated physicians to serve
inaccessible areas”.
Flavier’s common-sense programme
was much lauded in its time. Not only did it pinpoint, and seek to remedy, a
critical weakness in the healthcare environment, one that affected the most
economically deprived and vulnerable sectors of the population; it also made
urgent Flavier’s call, one that he had practiced himself for much of his
career, for doctors—especially those from the University of the Philippines
(UP) and other state colleges whose education is subsidised by the citizenry—to
“give back” to the country by rendering service in places where they’re needed
most.
The government is said to
subsidise about 80 per cent of a student’s education in UP; unfortunately,
according to a GMA-7 report last year, “data from the UP College of Medicine
showed that more than 80 per cent of their graduates eventually leave the
country to practice medicine overseas, and the number has been increasing in
the past 10 years.”
This has led to a new university
policy, called the Return Service Programme, in which incoming freshmen to
medical colleges in UP schools are required to sign a commitment saying that
after they graduate, they will stay and serve the country for a specific number
of years—three for those under the medicine programme, two for students from
allied disciplines such as dentistry, nursing, pharmacy, public health and
health sciences.
Not all of them will find
employment, of course, in city-based hospitals and medical institutions. So
they may well consider the DTTB programme, which, nearly 20 years after Flavier
sounded the call, turns out to have grown very significantly.
Last week, Ona announced that the
Philippines would no longer have “doctorless” municipalities by the end of the
year, with 32 “doctorless” and “very poor” municipalities in Abra, Ilocos Sur,
Cagayan in the north and Palawan, Tawi-Tawi and Basilan in the south finally
about to have their own physician by December through the DTTB programme.
How did the DOH do it? By
assiduous recruitment, apparently, resulting this year in 114 new recruits, on
top of the 72 doctors already deployed to various fifth- or sixth-class
municipalities all over the country since last year that cannot afford to hire
their own doctor.
“Since 1993, 553 physicians have
served in 390 municipalities all over the Philippines,” said Ona. “Presently,
our doctors are serving in 68 municipalities in 38 provinces and 16 regions
across the country.”
Ona’s address at the recent
commencement exercises of the new doctors didn’t skip the caveats. “The road
will not be easy,” Ona said, the difficulty stemming right off from the sheer
weight of the job. DTTB doctors could serve up to 50,000 people, or more than
double the doctor-to-population ratio of 1:20,000 set by the World Health
Organisation, he said. For young doctors, two years of such crushing work may
be daunting.
“But the journey has its
rewards,” Ona added. “No doubt, your communities will adopt you as one of their
own and pamper you in their little way, in their humble way. Experiences, both
good and bad, will give colour to your tours of duty. You will find
fulfillment, however, in every patient you treat, comfort, and hopefully heal.”
The government is doing its bit
to sweeten the deal not only with incentives such as clothing, subsistence,
laundry and hazard allowances, but also with postgraduate study opportunities
for the young doctors.
Of the new batch of 114 DTTB
doctors, 92 are said to have already been dispatched to various areas. The
communities they serve—and the larger nation whose well-being benefits from
their heroic work—will no doubt be grateful. DOH’s next goal must be to deploy
more than one of these physicians to a target community, to decrease the
doctor-to-population ratio. In other words, may their tribe increase, indeed.
Editorial Desk
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